What is Allegron (Nortriptyline) 10mg?

Allegron (Nortriptyline) 10mg

Allegron 10mg is a tricyclic antidepressant (TCA) medication containing nortriptyline hydrochloride, primarily indicated for the treatment of depression, but also commonly used off-label for neuropathic pain management. 1

Medication Details

• Allegron contains nortriptyline hydrochloride, which is chemically known as 1-propanamine, 3-(10,11-dihydro-5H-dibenzo [a,d] cyclohepten-5-ylidene)-N-methyl, hydrochloride 1
• It is available as a 10mg oral tablet formulation 1
• It belongs to the tricyclic antidepressant class of medications 2
• The FDA-approved indication is for the relief of symptoms of depression, with endogenous depressions being more likely to respond 1

Clinical Uses

Primary Indication

• Treatment of depression 1

Common Off-Label Uses

• Management of neuropathic pain conditions 2
• Chronic pain syndromes including chronic low back pain 3
• Prevention of migraine headaches 2
• Adjunctive treatment for irritable bowel syndrome 2

Pharmacological Properties

• Nortriptyline works by inhibiting the reuptake of both norepinephrine and serotonin in the central nervous system 4
• It has less anticholinergic activity compared to other tricyclic antidepressants like amitriptyline 4
• It is considered a secondary amine tricyclic antidepressant 2
• Nortriptyline tends to be more sedating than desipramine but less sedating than amitriptyline 4

Dosing Information

• For depression treatment:

  • Starting dose is typically 10mg at bedtime 2
  • Can be gradually increased to 40mg per day (given twice daily) 2
  • Maximum dosage may range from 75-150mg daily in more severe cases 5

• For neuropathic pain:

  • Starting dose is typically 10-25mg at bedtime 4
  • Dose is gradually titrated upward as needed and tolerated 2

Advantages Over Other TCAs

• Nortriptyline has a more favorable side effect profile compared to amitriptyline 4
• It has a therapeutic "window" blood level of 50-150 ng/mL, making it easier to monitor 2
• It may be particularly useful in patients with agitated depression and insomnia due to its moderate sedating properties 2
• For elderly patients, nortriptyline is often preferred over other TCAs due to fewer anticholinergic effects and less orthostatic hypotension 6

Common Side Effects

• Sedation/drowsiness 2
• Dry mouth 4
• Constipation 4
• Urinary retention 4
• Blurred vision 4
• Weight gain 4
• Orthostatic hypotension (less common than with amitriptyline) 5

Clinical Considerations

• Regular monitoring is recommended when using nortriptyline, especially in patients with cardiac conditions 4
• Blood level monitoring may be helpful in optimizing therapy, with a therapeutic window of 50-150 ng/mL 2
• For pain management, nortriptyline is often effective at lower doses than those required for depression 4
• In neuropathic pain treatment, nortriptyline is considered a second-line option after first-line treatments have failed 2
• For chronic pain conditions, studies show modest pain reduction (22% vs 9% with placebo) 3

Special Populations

• In elderly patients:

  • Lower starting doses are recommended 4
  • Nortriptyline is often preferred over other TCAs due to its better safety profile 6
  • Careful monitoring for side effects is still necessary 6

• In patients with cardiac conditions:

  • Use with caution due to potential effects on cardiac conduction 4
  • Generally safer than tertiary amine TCAs (like amitriptyline) 6